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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Beyond initial recovery: Heart failure with transient vs sustained improvement in left ventricular ejection fraction
Rasha Kaddoura, Ammar Chapra, Jassim Shah, Mohamed Izham, Rajvir Singh, Haisam Alsadi, Maha Al-Amri, Tahseen Hamamyh, Manar Fallouh, Farras Elasad, Mohamed Abdelghani, Sumaya Alsaadi Alyafei, Amr Badr, Ashfaq Patel
Rasha Kaddoura, Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
Ammar Chapra, Jassim Shah, Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
Mohamed Izham, Department of Clinical Pharmacy and Practice College of Pharmacy, QU Health Sector, Qatar University, Doha 2713, Qatar
Rajvir Singh, Department of Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
Haisam Alsadi, Tahseen Hamamyh, Manar Fallouh, Farras Elasad, Mohamed Abdelghani, Amr Badr, Ashfaq Patel, Department of Cardiology, Hamad Medical Corporation, Doha 3050, Qatar
Maha Al-Amri, Sumaya Alsaadi Alyafei, Department of Pharmacy, Hamad Medical Corporation, Doha 3050, Qatar
Co-corresponding authors: Rasha Kaddoura and Ammar Chapra.
Author contributions: Kaddoura R, Chapra A, Shah J, Izham M, Singh R, Alsadi H, Al-Amri M, Hamamyh T, Fallouh M, Elasad F, Abdelghani M, Alsaadi Alyafei S, Badr A, and Patel A made a substantial, direct, and intellectual contribution to the work and approved it for publication; Kaddoura R and Chapra A contributed equally to this article and are the co-first authors of this manuscript; All authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Hamad Medical Corporation Medical Research Center, approval No. MRC-01-20-139.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment with verbal consent according to the usual standard of care.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rasha Kaddoura, Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Al-Rumailah, Doha 3050, Qatar.
rasha.kaddoura@gmail.com
Received: March 5, 2025
Revised: April 2, 2025
Accepted: May 16, 2025
Published online: June 26, 2025
Processing time: 107 Days and 10.4 Hours
BACKGROUND
There is no available data about the trajectory of heart failure (HF) with improved ejection fraction (EF) and patient clinical outcomes in Qatar.
AIM
To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction (LVEF) and to determine the independent predictors for sustained improvement in LVEF.
METHODS
This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018. This study included adult patients with improved LVEF and had at least three echocardiographic studies. The patients were divided into two groups: HF with transient improvement in EF (HFtimpEF) and HF with sustained improvement in EF (HFsimpEF).
RESULTS
A total of 175 patients with HF and improved EF were included. Among them 136 (77.7%) patients showed sustained improvement in LVEF. The remaining patients with HFtimpEF were predominantly males [37 (94.9%) vs 101 (74.3%), P = 0.005] with a higher incidence of ischemic cardiomyopathy [32 (82.1%) vs 68 (50.4%), P = 0.002], dyslipidemia [24 (61.5%) vs 54 (39.7%), P = 0.03], and hypertension [34 (87.2%) vs 93 (68.4%), P = 0.03] than those with HFsimpEF. The latter experienced significantly lower rates of hospitalization [39 (28.7%) vs 20 (51.3%), P = 0.01] and diagnosis of new cardiovascular conditions during the follow-up (e.g., acute coronary syndrome, stroke, decompensated HF, and atrial fibrillation) [14 (10.3%) vs 10 (25.6%), P = 0.03] without a difference in emergency department visits or in-hospital death. Sustained improvement in LVEF was positively associated with being female [adjusted odds ratio (aOR) = 6.8, 95% confidence interval (CI): 1.4-32.3, P = 0.02], having non-ischemic etiology of HF (aOR = 3.1, 95%CI: 1.03-9.3, P = 0.04), and using a mineralocorticoid receptor antagonist (aOR = 7.0, 95%CI: 1.50-31.8, P = 0.01).
CONCLUSION
Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiovascular conditions than patients with HFtimpEF. Sustained improvement in LVEF was positively associated with being a female, having non-ischemic etiology of HF, and using a mineralocorticoid receptor antagonist.
Core Tip: Our study reported observations from a population with heart failure in Qatar, a Middle Eastern country that is usually underrepresented in major clinical trials. This study was the first in the Middle East to characterize the clinical features and outcomes of patients with heart failure who demonstrate either sustained or temporary improvement in left ventricular ejection fraction.
